Ward_X

My facility also has HCLL/Epic. We have manila folders/envelopes to keep full workups on patients with antibody histories. You can always refer to the full panels and order of testing when doing crossmatches or new workups. Filing cabinets sort them alphabetically, and recently we purged folders of patients who were pretty old. Theoretically, anyone could go fully digital, but it's a downtime record for now. We have a backup server that stores preliminary testing data that we check periodically throughout the day to see if T/S information crossed over. That way, if HCLL is down, you can see typing results there. No paper records exist for patients without antibodies.

Protein problem patients, especially a cancer population, maybe?

We use COBE 2991s, and use protein dipsticks to test the supernatant. The positive control is diluted plasma and we dilute it to get a level of 30, the negative control is saline, and the samples are collected from the wasteline after the washing is done. The washed sample should test for negative or trace protein, following Standard 5.7.4.6, which lists that washed cells should be prepared in a way that removes almost all of the plasma. We don't look at the crit for these. There are some other threads on here that also discuss washed QC -- I would also search for those!

That's a great point, and my lab operates the same way with our software. I did notice we actually have an order for an MTP that will crossover to us from them, but doctors seldom use it. The few times I have seen it, they verbally order and then file it electronically ex post facto. The mere fact this exists means that hopefully there can be a way to adapt it in the future or stress to use it more.

What programmers should really add to systems like EPIC and the like is signature capabilities under an emergency release record. If a record can say the units were EI and it's already in the patient's file, how convenient would it be if a doctor could sign the consent off that?

At what rates have you been trashing the opened units? Does your individual bagging cause more conservative usage?

The amount of times that I have encountered a doctor that refused to transcribe critical information to a Blood Bank paper record is astronomical. We usually send a form with the emergency pack and if it's not signed when its returned, we send it back to them and someone signs it. It would be easier to get rid of the whole paper signing business, but it serves as a downtime record in and of itself if you cannot issue the units or cannot pull the care team that ordered the emergency. Just a thought.

Is it possible that a sample was drawn in a different tube/additive then poured into the pink top?

I don't see why you'd reject a sample just for not being full, that seems a bit unnecessary. QNS or a short sample, obviously, but most patients come through for their T/S, the screen is negative, and that's it. If you had to wait for a new sample, their old sample could have been done by then. Additionally, calling for "fuller tubes" isn't really the way to ensure higher quality in patient care. Overall, not worth the effort. The care teams on the floor are already quite unhappy when they have to redraw for other reasons, I can't imagine what they'd say if I called requiring a completely full sample! Their fragile stick patients may not be happy either...

My facility has a plastic rectangle with a notch in the middle, not sure if this is its original usage, but it has "American Dade" written on it. It's held in place by the same swing mechanism for regular glass slides. You could just carve out a piece of wood and sand it, maybe?

Coolers can still go... I think the units in the cooler are more of the issue, but it seems by the responses above that facilities have created their own workarounds.

Whatever units you issue, do you just assume they're not coming back then? You treat it as "once theyre gone theyre gone" ?

I'd parrot the same sentiments listed above. As long as you have ruled-out all other clinically significant antibodies, call the identification a low frequency and call it a day. You'll have to perform any future crossmatches with the same methodology. The chances of it being some crazy rare antibody is, of course, low. There was also another thread listed here with a similar question.

The bags are engineered with a sort of "breathable" membrane, so you could, in a way, poison the product. We have found floors trying to wipe down units with bleach before they come back to the Blood Bank, which totally isn't okay !!!! but, they wouldn't know otherwise. The products would have to be discarded,

Same as many above, also use saline as a neg. control for CC so it's "accidentally" QC'd. The cubes are also inspected on a daily basis as part of the Cellwasher QC, which checks for valid expiration date of 30d on the cube and that there is sufficient volume. Switched over to PBS somewhat recently, all the procedures were modified.